Provider Demographics
NPI:1609423417
Name:BASAMI HOUSE,LLC
Entity Type:Organization
Organization Name:BASAMI HOUSE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODONGO
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:602-903-9193
Mailing Address - Street 1:PO BOX 42927
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-2927
Mailing Address - Country:US
Mailing Address - Phone:602-903-9193
Mailing Address - Fax:
Practice Address - Street 1:125 W VILLA RITA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6450
Practice Address - Country:US
Practice Address - Phone:602-903-9193
Practice Address - Fax:623-322-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness